What Is Neonatal Tetanus?

Neonatal tetanus is also known as "four or six winds", "umbilical wind", "seven days wind", etc., caused by Clostridium tetanus invading the umbilicus, producing toxins, causing tooth closure and systemic muscle tonic spasm as Characteristics of acute severe infectious disease. With the application and promotion of new urban and rural delivery methods in China, the incidence of this disease has been significantly reduced. But in remote mountain areas, rural and private birth attendants can still occur.

Basic Information

nickname

Forty-six wind, umbilical wind, seven-day wind

Visiting department

Pediatrics

Common causes

Clostridium tetanus invades umbilicus

Common symptoms

Crying, not mouth wide, difficulty sucking

Causes of neonatal tetanus

Pathogenic bacteria

Clostridium tetanus is Gram-positive and clostridium anaerobic. The bacteria are widely distributed in nature. It is found in soil, dust, human and animal manure. Extremely strong resistance, can survive for decades in the light-irradiated soil, can withstand boiling for 60 minutes, dry heat at 150 ° C for 1 hour, 5% carbolic acid for 10 to 15 hours. High pressure disinfection is required to kill it with iodine-containing disinfectants such as iodine or other disinfectants such as epoxyethylamine.

2. Mode of infection

When the umbilical cord is broken, the hands of the midwife or the scissors and gauze used are not disinfected or sterilized inadequately, or the umbilical cord is not cleaned and disinfected after birth. Most occur 4 to 7 days after birth.

Clinical manifestations of neonatal tetanus

The incubation period is 4 to 7 days. The shorter the period, the more severe the disease, and the higher the mortality. The early symptoms are crying, small mouth opening, and difficulty in sucking. For example, when you use the tongue depressor to press the tongue, the harder you open the mouth, the more difficult it is to open the tongue. Helps early diagnosis. Then the teeth were closed tightly, the facial muscles were tense, and the corners of the mouth were pulled, showing a "bitter smile" face, accompanied by paroxysmal clenched fists. Excessive flexion of the upper extremity, straightening of the lower extremity, reflexion of the angular arch, spasm of the respiratory muscles and laryngeal muscles can cause bruising asphyxia. Any slight stimulus (sound, light, light touch, drinking water, light pricks, etc.) can induce seizures. Children with convulsive symptoms are the characteristics of the disease. Those who can survive the convulsions after timely treatment (usually takes about 3 weeks), the seizures gradually decrease, the seizure interval is prolonged, and they can suckle. It takes about 2 to 3 months to fully recover. The course is often complicated by pneumonia and sepsis.

Neonatal tetanus examination

Surrounding blood

Infectious blood, increased neutrophil count.

2. Bacterial culture

The umbilical secretion culture can isolate tetanus bacillus, but only some children are positive.

3. Cerebrospinal fluid

Cerebrospinal fluid examination was normal.

4.X-ray chest radiograph

Examination can confirm the presence or absence of secondary pulmonary infections.

5. Brain CT

There are no obvious abnormalities and no intracranial hemorrhage, which can be distinguished from neonatal intracranial hemorrhage.

6. EEG examination

No obvious abnormalities.

Diagnosis of neonatal tetanus

Medical history plus typical onset symptoms after birth are generally easy to diagnose, and when there is no typical manifestation early, a positive tongue depressor test can also confirm the diagnosis.

Neonatal Tetanus Treatment

Controlling spasms, preventing infections, and ensuring nutrition are the three main points of treatment.

Control spasm

Is the key to successful treatment.

(1) Diazepam (Diazepam) is the first choice. Slow intravenous injection can reach the effective concentration within 5 minutes. However, the half-life is short and it is not suitable for maintenance treatment. Once every 4 to 6 hours, the interval between severe medications can be shortened to once every 3 hours. After the spasm is temporarily stopped, the gastric tube is left.

(2) Phenobarbital sodium is the drug of choice for the treatment of other neonatal convulsions, but it is used for tetanus and it is difficult to control spasms well. It can be used alternately with diazepam.

(3) 10% chloral hydrate is injected into the stomach tube or enema as a temporary medication during an attack.

(4) Paraaldehyde has a fast and safe antispasmodic effect, but it is mainly excreted by the lungs to stimulate the respiratory mucosa. It should not be used when there is pneumonia. Mostly used temporarily.

(5) thiopentone sodium can be used when the above drugs are still convulsed. Intramuscular or slow intravenous injection.

2. Anti-virus

Horse serum tetanus antitoxin (TAT) can only neutralize free tetanus toxin, and has no effect on ganglioside toxins. Therefore, the sooner you use it, the better.

3. Antibiotics

Intravenous infusion of penicillin or cephalosporin and metronidazole can kill tetanus.

4. Nursing

Keep the child in a quiet, dark environment, and minimize irritation to reduce seizures. Necessary operations such as temperature measurement, turning over, etc. should be performed as concentratedly as possible. Remove sputum in time to keep the airway open and mouth and skin clean. At the beginning of the disease, fasting should be temporarily provided, nutrition and drugs should be supplied through the vein, and the stomach tube feeding should be given after the spasm is reduced. The umbilicus is washed with 3% hydrogen peroxide, and then iodine is applied to eliminate residual tetanus.

Neonatal tetanus prevention

1. Vigorously promote the new method of delivery: After the newborn is born, the umbilical cord must be handled strictly. Strict implementation can completely prevent this disease.

2. For those who have poor delivery and disinfection, try to cut off the distal end of the remaining umbilical cord within 24 hours, and then re-ligate. The proximal end should be washed with 3% hydrogen peroxide or 1: 4000 potassium permanganate solution, and then coated with iodine. Intramuscular injection of tetanus antitoxin or human immunoglobulin.

3. For pregnant women who cannot guarantee sterile delivery, a method of injecting tetanus toxoid into pregnant women is currently being carried out. This method can effectively prevent the occurrence of neonatal tetanus.